Controlling interest

A pilot scheme that puts care service users in far greater charge of their own funding budgets is proving popular and efficient. And, as David Brindle reports, ministers have now latched on to the idea

Controlling interest

A pilot scheme that puts care service users in far greater charge of their own funding budgets is proving popular and efficient. And, as David Brindle reports, ministers have now latched on to the idea

Joseph Tomlinson is a fairly typical 16-year-old, except that he has a severe learning disability. As a result, he has never had a good friend of his own age. Now, though, he and his family have taken on another 16-year-old as one of four personal assistants they employ for him under a scheme that is emerging as a cornerstone of government thinking on adult social care.

This is not the standard direct payments system that local authorities have been operating, with mixed results, since 1997. Joe Blott, assistant director of adult services at Wigan, where the Tomlinsons live, admits that the council could not recruit a 16-year-old for hands-on care services and could not sanction such recruitment under direct payments.

Rather, the Tomlinson family is one of the first to take advantage of a scheme called In Control - "a step beyond direct payments", according to Blott - by which people are not only given the cash to choose their own service providers, but are free to design their own bespoke service. Once their needs are assessed, and funding allocated, they can - within reason - spend it how they wish.

We will be hearing much more of this kind of approach. Improving the Life Chances of Disabled People, a report published by the prime minister's strategy unit in January, foreshadows the establishment of a very similar system of individual budgets across England by 2012. And the principle seems certain to extend further. Stephen Ladyman, community minister at the Department of Health, has said that the imminent green paper on adult social care as a whole will contain more of the same.

The Wigan scheme is one of six In Control pilots, but probably the most advanced. The overall project is led by learning disability charity Mencap, with the backing of the government's Valuing People support team among others, and is designed to reorganise social care as "self-directed support".

The key to the approach - and to the strategy unit's thinking - is one-stop assessment and resource allocation. This means the aim is to pull together all potential sources of support for the disabled person, achieving ultimately a single process and outcome. In Wigan, for instance, social services is engaging with the council's education department, the NHS primary care trust, the Connexions service for teenagers and the Learning and Skills Council.

Steve Jones, the local authority's chief executive and an enthusiast of the pilot, says: "The trick is to bring together two things: really good person-centred planning and 'sup ported' direct payments. If you get those in place, housing, health, whatever are elements you can fit on the spine of the person-centred plan."

Initially, 20 families applied to be involved in the Wigan scheme. Fifteen were selected and 13 remain, one having decided to seek reassessment for supported housing and a second having grown impatient with the time things were taking. Indeed, only now - after 18 months - is hard cash starting to be released to the families furthest forward in the process.

One such family is that of 20-year-old Laura Hughes, who has a learning disability and complex health needs. For 17 years, the family struggled without any direct support. Now, after completion of a person-centred plan in which Laura was helped to articulate her interests and ambitions, she has five personal assistants through the week who enable her to go to college and sustain a job delivering and emptying collection boxes for cerebral palsy charity Scope.

"It's like being set free, for all of us," says Laura's father, Tom. He and his wife, Eileen, have two other children. Although the family had experience of direct payments, In Control has seemed qualitatively different.

"With direct payments you are limited on the hourly rate you can pay, who you can employ - no members of the family - and so on," says Tom Hughes. "With In Control, if you want to pay someone £30,000 for three months of the year, it's OK, but then all your budget has gone."

Eileen Hughes says the effect on Laura has been striking. "She is with people of her own age group, she has got friends, and we never, ever thought she would have a little job. She's loving it."

Under Wigan's scheme, resources are allocated in three bands - up to £10,000, £20,000 or £30,000 a year - and it is true that disabled people and their families may spend the money as they choose, provided statutory requirements such as the minimum wage are met.

"Rather than saying, 'There's your services'," explains Dave Westlake, In Control team manager, "we say, 'That's how much you have got. Draw up your own plan'."

This support plan must, however, be agreed by a care manager to ensure, in the words of In Control's national guidance, that it "makes sense and is in the best interests of the individual".

One benefit for the council is that families are not spending up to their limits. "We are finding they spend lower, and the odds are that they spend it more efficiently," says chief executive Jones. He is convinced that the approach has lessons for the council in other service areas.

"If we can carry this off with people with such complex needs, it ought to be the case that the lessons are trans ferable to nearly everything else we do where we have a service relationship."

Could any service user handle the responsibility, though? Blott admits it is not for all his social services clients, and it is significant that many of the In Control families had previously undergone a Partners in Policymaking course - an intensive training programme for disabled adults and parents of disabled children, imported from the US - which appears to have had a profound impact on their confidence and understanding of the policy process.

Joseph Tomlinson's mother, Caroline, did a course in 1996. But she says that only now, with In Control, does she feel, well, in control.

"I had 30 or 40 different people coming through my house before," she says of the previous support services. "I did not know them from Adam. They were coming in and putting my son in the bath - and he's 16 years old! Once I was stark naked in my bedroom and a woman wandered in and said, 'Oh, I was looking for Joseph.' And then she wandered out again. It was appalling."